La Revue de médecine interne
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We report a case of cat-scratch disease neuroretinitis. A 26-year-old man was referred for severe right visual loss. Posterior segment examination showed a papilledema with macular edema. ⋯ Four weeks of antibiotic therapy combining oral ciprofloxacin and doxycycline led to progressive resolution of the neuroretinitis and improvement in visual acuity. This report reminds that B. henselae infection can be the cause of neuroretinitis. Its prognosis can be improved by early treatment.
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About forty percent of the patients with primary Sjögren's syndrome (pSS) experience chronic neuropathic pain with normal electrodiagnostic studies. Two previous studies suggest that chronic neuropathic pain in pSS is due to small fiber neuropathy (SFN). Quantification of epidermal nerve fiber density after skin biopsy has been validated to diagnose small fiber neuropathy. ⋯ Small fiber neuropathy is commonly responsible of chronic neuropathic pain in pSS. Prevalence, physiopathology and neurological evolution of such neuropathies still remain unknown.
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Candida species is the fourth most common cause of bloodstream infection and is the leading cause of invasive fungal infection among hospitalized patients. Acute disseminated candidiasis remains a life-threatening disease that now occurs mainly in intensive care units hospitalized patients. ⋯ Current guidelines for the management of invasive candidiasis recommend fluconazole or an echinocandin as the primary therapeutic option. The optimal choice of the antifungal agent should depend on local epidemiology, prior antifungal therapy and patient's characteristics.
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Uveitis is a common (20-50%) and early manifestation of sarcoidosis. Typical sarcoid uveitis presents with bilateral mutton fat keratic precipitates, iris nodules, and anterior and posterior synechia. Posterior involvement includes vitreitis, vasculitis and choroidal lesions. ⋯ Systemic corticosteroids are indicated in uveitis not responding to topical corticosteroids or in the presence of bilateral posterior involvement, especially with macular edema and occlusive vasculitis. In 5 to 20% of the patients who are corticosteroids resistant or require an unacceptable dose to maintain remission, additional immunosuppression is used, including methotrexate, leflunomide and mycophenolate mofetil. As in systemic sarcoidosis, infliximab has been recently suggested for refractory or sight threatening disease.
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Sarcoidosis is a multisystemic granulomatosis of unknown cause that predominantly affects the lung and the lymphatic system, especially intrathoracic. The diagnosis relies on the association of a compatible clinical and radiological presentation, the presence of characteristic histopathological lesions (non-necrotizing epithelioid granuloma with giant cells) and the exclusion of other potential causes of granuloma. ⋯ Severe complications of the pulmonary disease include stage IV sarcoidosis, pulmonary hypertension, bronchial stenosis and pulmonary aspergillosis. In-depth knowledge of pulmonary sarcoidosis is required to ensure the diagnosis of this non-rare disorder of multiple presentation, to identify potentially severe cases and to guide therapeutic decision.